Complications of cerebrospinal fluid drainage in thoracoabdominal aortic procedures

Cerebrospinal fluid (CSF) drainage is used to reduce spinal cord ischemia (SCI) in patients undergoing thoracoabdominal aortic procedures. Recent literature has found high rates of complication associated with CSF drainage, which has led to changes in practice. The aim of this study was to investigate rates of CSF drain-related complications in patients undergoing a thoracoabdominal aortic procedure with perioperative placement of a CSF drain.

We conducted a single-centre retrospective cohort study. We defined major complications as intracranial hemorrhage, epidural hematoma or abscess, meningitis, and catheter retention requiring a reoperation. Minor complications assessed included drain-induced neurologic deficits, CSF leak, postdural puncture headache, asymptomatic blood in the CSF, drain failure, and catheter retention not requiring a reoperation. We recorded postoperative neurologic deficits as secondary outcomes.

There were 129 patients who met the inclusion criteria. We found 5 cases of permanent paraplegia in the overall cohort (3.9%), with only 2 occurring in the patients with prophylactic CSF drains (1.6%). There were no major CSF drain-related complications. The rate of minor complications was 17.8%. We found no association between complication rates and indication for procedure or type of operation.

The lack of major complications in this series adds to existing variability in recent literature and provides support for continued use of this adjunct for SCI prevention. Further research is required to identify the etiology of significant differences in CSF drain complication rates seen at other centres.